By:Dr.Amany.

comprehensive health supervision of a pregnant woman before delivery Or it is planned examination, observation and guidance given to the pregnant woman from conception till the time of labor.

To reduce maternal and perinatal mortality and morbidity rates To improve the physical and mental health of women and children

To ensure that the pregnant woman and her fetus are in the best possible health. To detect early and treat properly complications Offering education for parenthood

To prepare the woman for labor, lactation and care of her infant

The first visit or initial visit should be made as early is pregnancy as possible. Return Visits: Once every month till 7th month. Once every 2 weeks till the 9th month Once every week during the 9th month, till labor.

Assessment

History

Examination

Investigation

Personal history Family history Medical and surgical history Menstrual history Obstetrical history History of present pregnancy

Fundal height Maternal weight Blood pressure measurements Fetal heart auscultation Urine testing for protein and glucose Questions about fetal movement

Evidence supporting these practices is variable

Height of over 150 cm indication of an averagesized pelvis

The approximate weight gain during pregnancy is 12 kg.; 2kg in the first 20 weeks and 10 kg in the remaining 20 weeks (1.5 kg per week until term).

Obesity (more than 20 kg above the weightheight formula) leads to an increased risk of gestational diabetes, pregnancy-induced

hypertension and Thrombo-embolic disorders

The uterus may be higher than expected due to large fetus, multiple pregnancy, polyhydramnios or mistaken date of last menstrual period. The uterus may be lower than expected due to small fetus, intrauterine growth retardation, oligohydramnios or mistaken date of last menstrual period.

Measured from pubic symphysis to uterine fundus

Should measure +/- 2 cm compared to weeks gestation

Fetal heart sound is heard by sonicaid as early as 10thweek of pregnancy.

Fetal heart sound is heard by Pinard' s fetal stethoscope after the 20thweek of pregnancy.

The normal fetal heart rate is 120-160

beats/min

Urine should be tested for sugar, ketenes' and protein.

Hemoglobin will be repeated: At 36 weeks of gestation. Every 4 weeks if Hb is < 9 g/dl.

Contraindicated

Case Dependent

measles mumps rubella yellow fever

polio influenza rabies hepatitis A/B pneumococcal tetanus toxoid

 The

pregnant woman reports at least 10 movements in 12 hours.

of fetal movements precedes intrauterine fetal death by 48 hours.

Absence

Physiological changes during pregnancy Weight gain Fresh air and sunshine Rest and sleep Diet Daily activities Exercises and relaxation Hygiene Teeth Bladder and bowel Sexual counseling

Smoking : Medications Infection Irradiation Occupational and environmental hazards Travel Follow up Minor discomforts Signs of Potential Complications

Exercise should be simple,

mild exercise avoid lifting heavy weights

A tooth can be extracted

during pregnancy, but

local analgesia is
recommended

Catheter and enema should be avoided.

Smoking may lead to

Ptyalism, nervousness
and hyper emesis and

make pregnant woman

at increased risk of chest infections and thromboembolic disorders

Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetus Pregnant woman should avoid exposure to xray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia

Urinary frequency RELIEF MEASURES:

Decrease fluid intake at night.

Maintain fluid intake during day.

Void when feel the urge.

RELIEF MEASURES:
Rest frequency. Go to bed earlier.

RELIEF MEASURES:

Rest frequency
Decrease fluid intake at night Comfort position

RELIEF MEASURES:
Wear a good supporting bra. Assess for other conditions.

ETIOLGY: Elevated estrogen levels

RELIEF MEASURES :

Avoid decongestants.

Use humidifiers, and normal saline drops.

ETIOLGY: Unknown RELIEF MEASURES:

Perform frequent mouth care. Chew gum. Decrease fluid intake at night. Maintain fluid intake during day.

RELIEF MEASURES:
Avoid food or smells that exacerbate condition.
Eat dry crackers or toast before rising in morning. Eat small, frequent meals. Avoid sudden movements. Get out of bed slowly Breath fresh air to help relieve nausea.

RELIEF MEASURES:
Use extra pillows at night to keep more upright.
Limit activity during day

RELIEF MEASURES:
Eat small, more frequent

meals.
Use antacids. Avoid overeating and spicy

foods.

Avoid standing for

long periods.

Elevate legs when laying or sitting.

Avoid tight stockings.

 Rest in sims'

position. Elevate legs regularly. Avoid crossing legs. Avoid tight stockings. Avoid long periods of standing

RELIEF MEASURES: Maintain regular bowel habits. Use prescribed stool softeners. Apply topical or anesthetic ointments to area.

RELIEF MEASURES: Maintain regular bowel habits. Increase fiber in diet. Increase fluids. Find iron preparation that is least constipating

RELIEF MEASURES:
Take a daily bath or

shower. Wear cotton underwear.

RELIEF MEASURES: Wear shoes with low heels.

Walk with pelvis tilted

forward.

Use firmer mattress.

RELIEF MEASURES:
Extend affected leg and dorsiflex the foot.
Elevate lower legs frequently. Apply heat to muscles. Evaluate diet.

RELIEF MEASURES:
Rise slowly from sitting to standing. Evaluate hemoglobin and Hematocrit. Avoid hot environments

Anxiety: pregnancy is a developmental turning point as childless couples become parents. Lifestyle changes occur. The reality of labor and birth. How will my life change after I have a baby? Social support is important. Affects both mother, father, siblings and grandparents.

Mother Ambivalence Acceptance Introversion Mood swings Changes in body image

Siblings Sibling rivalry Regression GRANDPARENTS Unsure of their role Support resource

Father Ambivalence about being a parent. Concern of moving into a parenting role. Stress due to financial issues, changing relationship with partner, his role in the pregnancy. Concern about their ability to parent. May exhibit signs or symptoms related to the pregnancy.

Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Temperature and chills Dizziness, blurring of vision

Persistent vomiting Severe headache Edema of hands, feet, face and legs Muscular irritability, convulsions Epigastric pain Oliguria, Dysuria Absence of fetal movement

thanks